Short bowel syndrome
Short bowel syndrome (SBS) is the consequence of massive small-bowel resection resulting in severe nutrient malabsorption that occurs due to loss of mucosal surface area. It is seen after surgical intervention for long-segment necrotising enterocolitis, mitgut volvulus, acute ischemic injury, small-bowel aganglionosis and other conditions involving the small bowel.
The amount of resection or remaining bowel generally dictates the degree of malabsorption and consequently the need for specialised enteral and/or parenteral nutrition. The patient can lose as much as half of the intestine if the duodenum, distal ileum, and ileocecal valve (ICV) are present. If the ICV is absent, patients may not be able to tolerate even a 25% loss of intestine without the help of total parenteral nutrition for the mainstay of their nutrition support, especially initially until adaptation takes place.[3,4]
Different centres may have different nutritional recommendations and local guidelines should be followed, but in general the following nutritional recommendations for paediatric SBS patients are: (1) enteral nutrition should be initiated as soon as possible after bowel resection to promote intestinal adaptation, and should be administered in a continuous fashion; (2) breast milk or standard polymeric formula (depending on the child's age) is recommended as the preferred source of nutrition; (3) bottle-feeding (small volumes) should be started as soon as possible in neonates to stimulate the suck and swallow reflexes; however when breast milk or polymeric formulae are not tolerated a semi-elemental feed is the feed of choice;(4) solid food can be introduced at the age of 4 to 6 months (corrected for gestational age if necessary) to stimulate oral motor activity and to avoid feeding aversion behaviour.
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- Duro D, Kamin D, Duggan C. Overview of pediatric short bowel syndrome. J Pediatr Gastroenterol Nutr 2008;47(Suppl 1):S33-6.
- Mascarenhas MR, Kelsen J. Short-bowel syndrome. In: Schwartz MW, ed. The 5-Minute Pediatric Consult. Lippincott Williams & Wilkins,2008.
- Goulet O. Nutritional management of intestinal failure & short bowel syndrome in children. In: Nutritional management of children with malabsorption/maldigestion with a focus on intestinal failure. International Round Table Discussion Paediatrics, 2009 (Nutricia data on file).
- Olieman JF, Penning C, Ijsselstijn H, et al. Enteral nutrition in children with short-bowel syndrome: current evidence and recommendations for the clinician. J Am Diet Assoc 2010;110:420-6.